DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182373

Surgical site infections post cesarean section

Sundari Lakshmi Devi, D. V. K. Durga

Abstract


Background: Surgical site infections are among the most common hospital acquired infections. They make upto 14-16% of inpatient infections. Objective of present study was to evaluate the risk factors associated with surgical site infections and the bacteria causing wound infections in obstetric operations and the antibiotic sensitivity and resistance pattern of the pathogens isolated.

Methods: 100 women with wound infection during hospital stay or within 30 days following surgery. Pus samples were collected from the wound site with help of sterile swabs under aseptic precautions and immediately transported to microbiology laboratory for culture and sensitivity.

Results: Most of the patients belonged to the age group of 21-25 years, contributing to 55% of the cases. Majority of the women are from rural areas (71%). 57% of the cases were unbooked. 90% of the SSI were seen in emergency surgeries. Anaemia (48%) was the most common medical risk factor followed by hypertensive disorders 25%. The risk of post operative infection has been shown to be proportional to volume of blood loss during cesarean section and duration of surgery. Staphylococcus aureus to be predominant organism of wound infection of which 21% were MRSA followed by Klebsiella and E.coli. The gram negative isolates were 100% resistant to ampicillin followed by 22.5% to third generation cephalosporins and aminoglycosides.

Conclusions: Proper assessment of risk factors that predispose to SSI is critical for the development of strategies for reducing the incidence of SSI and for identifying high risk patients requiring intensive postoperative surveillance.

 


Keywords


Antibiotics, Cesarean, Infection, Surgical site infections

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References


Skarzyńska J, Cienciała A, Madry R, Barucha P, Kwaśniak M, Wojewoda T etal. Hospital infection in general surgery wards. Przegl Epidemiol. 2000;54(3-4):299-304.

Van schalkwyk J, van Eyk N. Society of obstetricians and Gynaecologists of Canada Infectious disease committee. Antbiotic prophylaxis in obstetric procedures. J obstet Gynaecol Can. 2010;32(9):878-92.

Stanton CK, Holtz SA. Levels and trends in cesarean birth in the developing world. Stud Fam Plann. 2006;37(1):41-8.

Gaynes RP. Surveillance of nosocomial infections: a fundamental ingredient for quality. Infect Control Hosp Epidemiol. 1997;18(7):475-8.

Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992;13(10):606-8.

Schneid-kofman N, Sheiner E, Levy A, Holcberg G. Risk factors for post caesarean surgical site infection Obstet Gynaecol. 2000;95(3):367-71.

Hillan EM. Postoperative morbidity following Cesarean delivery. J Adv Nurs. 1995;22(6):1035-42.

Amenu D, Belachew T, Araya F. Surgical site infection rate and risk factors among obstetric cases of Jimma university specialized hospital, southwest Ethiopia. Ethiop J Health Sci. 2011;21:91-100.

Mitt P, Lang, K, Peri A, Maimets M. Surgical-site infections following cesarean section in an Estonian university hospital: post discharge surveillance and analysis of risk factors. Infect Control Hosp Epidemiol. 2005; 26(5): 449-54.

Claesson BE, Holmlund DE. Predictors of intraoperative bacterial contamination and postoperative infection in elective colorectal surgery. J Hosp Infect. 1988;11(2):127-35.

De D, Saxena S, Mehta G, Yadav R, Dutta R. Risk factors analysis and microbial etiology of surgical site infections following lower segment caesarean section. Int J Antibiot. 2013;10:1155-60.

Oslen MA, Buttler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infections after low transverse caesarean section. Infect Control Hosp Epidemiol. 2008;29(6):477-84.

Dr. C. Dutta. “Medical and surgical illness complicating pregnancy”. Textbook of obstetrics. H. konar, ed;2004; Central 6th edition, 262-305.

Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377(9761): 228-41.

Shapiro M, Muñoz A, Tager IB, Schoenbaum SC, Polk BF. Risk factors for infection at the operative site after abdominal or vaginal hysterectomy. N Engl J Med. 1982;307(27):1661-6.

Hagglund L, Christenson KK, Christenson P, Kammec. Risk factors in caesarean section infection Obstet Gynaecol. 1988;72:559-64.

Ott WJ. Primary caesarean section; factors related to postpartum infection. Obstet Gynaecol. 1981;57: 171-6.

Trans TS, Jamulitrat S, chongsuvivatwong V, Geater A. Risk factors for post cesarean surgical site infection. Obstet Gynaecol. 2000;95(3):367-71.

Lilani SP, Jangale N, Chowdhary A, Daver GB. Surgical site infection in clean and clean-contaminated cases. Indian J Med Microbiol. 2005;23(4):249.